[The significance of an allergological examination in asthma and COPD]

Of the two most common obstructive lung diseases - bronchial asthma and chronic obstructive pulmonary disease (COPD) - asthma is clearly associated with a possible allergic background, therefore an allergological examination should be included in the work-up of this disease. COPD on the other hand is usually not expected to be linked with an atopic diathesis. Medical history, clinical manifestations, the presence of other atopic diseases, prick tests and measurement of specific IgE antibodies in the serum provide an indication of an allergic genesis of the obstructive pulmonary disease. Bronchial asthma can be roughly divided into an allergic phenotype (TH2-weighted) and a non-allergic phenotype (non-TH2-weighted). The TH2- weighted form leads to an infiltration of eosinophils into the bronchial wall allowing the possibility of a higher concentration of nitrogen oxide in the exhaled air (FeNO measurement) to be detected. In addition to the differentiation between allergic and non-allergic bronchial obstruction, an evaluation of symptoms associated with the workplace (work related asthma) must take place. Furthermore, questions about an intolerance to aspirin (aspirin - exacerbated respiratory disease) or exercise induced symptoms (exercise-induced asthma) should be asked. After a careful interpretation of clinical symptoms and findings in allergy tests, an allergologist can analyze the usefulness of a specific immunotherapy (SIT). For children who suffer from allergic rhinoconjunctivitis, an early SIT can prevent the shift to inflammation of the lower respiratory tract (asthma). Due to the overlapping pathophysiology and symptomatology between bronchial asthma and chronic obstructive pulmonary disease an allergological examination should be considered also in COPD patients.